Provider Demographics
NPI:1407242282
Name:MALDONADO, AIXA JANET
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:JANET
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAGO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7057
Mailing Address - Country:US
Mailing Address - Phone:915-253-4543
Mailing Address - Fax:915-307-4593
Practice Address - Street 1:101 LAGO GRANDE DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7057
Practice Address - Country:US
Practice Address - Phone:915-253-4543
Practice Address - Fax:915-307-4593
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)